Developing dysplasia of a hip is a frequent musculoskeletal condition in newborns. Infants with developing dysplasia of a hip, whether untreated or treated have a higher degree of early – onset hip osteoarthritis in adulthood. Proof to support universal screening by ultrasonography or physical examination is limited and often conflicting.
Some recent studies started to support assessment for limited hip abduction at eight weeks of age, which is the most delicate test for developmental dysplasia of the hip from this age onwards. Infants with overtly dislocate or dislocated hips should be referred to an orthopaedist on a priority basis at the time of diagnosis. Infants with unsure or confusing hip examination findings at birth can be examined again in two weeks. If there is a partial dislocation or dislocation at the follow – up examination, referral should be made at that time. If the examination findings are still not sure, the infant needs to undergo ultrasonography of the hips or be examined again and again every few weeks through the first six weeks of life. Though unsure findings generally resolve spontaneously, infants with persistent unsure findings of developing dysplasia of a hip longer than 6 weeks should be evaluated by an orthopaedist. Generally, the treatment involves flexion – abduction splinting.
Frequently Asked Questions (F.A.Q.)
1. What are the methods used for screening?
The Ortolani (minimizing a dislocated hip) and Barlow (dislocating a movable hip) maneuvers are the physical examination tests most generally performed for detection of DDH in initial infancy. By 2 – 3 months of age, the Ortolani, and Barlow maneuvers are less useful and assessment for limited hip abduction becomes the preferred analysis method.
Ultrasonography has also been used for DDH screening. Many ultrasound methods have been described, but in common, the evaluation involves a transverse view and a coronal view with the hip in flexion.
2. How accurate are the different screening methods?
There are few data on the correctness and interexaminer consistency of the Barlow and Ortolani maneuvers, though the experience and training of the physician performing them have been shown to control their accuracy. Similarly, though limited hip abduction is suggested as the ideal assessment method after two months of age, proof to support this advice is mixed. Conducting screening ultrasonography finds more flaws, thereby leading to rising in the diagnosis of DDH.
3. Is there any proof showing that screening results in superior consequences compared with no screening?
In spite of undetermined proof, the present day standard of care is based on a recommendation to perform physical examination screening.
4. What steps should be taken when screening test outcome are positive?
Infants with unsure abnormal results on first newborn examination (i.e. finding of a partial dislocation or dislocation) should be referred to an orthopaedist who is experienced in detection and management of DDH. This referral should occur on a preferential basis at the time of determination. If the findings on physical examination are unsure, a constant examination should be done in two weeks.
5. What is the general treatment?
Infants younger than six months with overtly dislocate or dislocated hips are generally treated with flexion – abduction splinting using a device like “Pavlik harness”. With mild uncertainty, as noted previously, one suggested approach is watchful waiting with bi – monthly examination for up to six weeks. If the mild certainty persists beyond six weeks, the patient should be referred to an orthopaedist for splinting.
6. What are the threats of this treatment?
The most vital adverse effect of DDH surgery or treatment is avascular necrosis of the femoral head. The major problem of avascular necrosis is the early – onset of osteoarthritis and the requirement of hip replacement surgery. Femoral nerve palsy, musculotendinous contracture, and pressure ulcers are the further risks of surgical treatment and splinting.
Cost for DDH Surgery
The DDH surgery cost varies from one case to the other. The most affordable cost for DDH surgery is found in India. India is the one and only destination where one can get this surgery done at a very low-cost.